Atorvastatin after 70 cut cardiovascular events but did not extend disability-free life

The edition in brief

STAREE randomised 9,971 Australians aged 70 or older without cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo. Over a median 5.9 years, major cardiovascular events fell (HR 0.70, 0.61–0.82; 10.9 vs 15.5 per 1,000 person-years) but the composite of death, dementia or persistent disability did not (HR 0.94, 0.84–1.05). Serious adverse events were similar, with more musculoskeletal, hepatobiliary and diabetes-related events on atorvastatin. ICare-FASTER, a stepped-wedge cluster trial across six emergency departments and about 60,000 presentations, found that point-of-care high-sensitivity troponin I within an accelerated pathway cut length of stay by 13%, about 47 minutes, with 30-day infarction or cardiac death unchanged at 0.39%. A meta-analysis of observational cohorts linked anabolic steroid use to more than double all-cause mortality (RR 2.57, 1.98–3.33), though causation cannot be inferred. A network meta-analysis of 284 trials ranked aquatic, isometric and mind-body exercise among the most effective for blood pressure. The pearl covers how to discuss primary-prevention statins with older patients.